Ribavirin may reduce use of clotting factors in hemophilia and Hep C

Findings based on case series in this week's issue of JAMA, show that ribavirin in combination with interferon, and possibly alone, may reduce the use of clotting factors in patients with hemophilia and chronic Hepatitis C.

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Ribavirin has been used in combination with interferon-alfa to treat chronic Hepatitis C.

This combination therapy has been reported to be more effective than interferon monotherapy for eradicating Hepatitis C virus, including that occurring in patients with concomitant hemophilia.

Dr Takamatsu and colleagues from Japan aimed to assess the reduction in the use of clotting factors in Hepatitis C-positive patients with hemophilia treated with ribavirin and interferon.

The researchers treated 8 consecutive patients with hemophilia as outpatients for Hepatitis C infection with interferon and ribavirin between June 2002 and November 2003 at Nagoya University Hospital.

The team reported that all patients were men with a mean age of 45 years of which 6 patients had hemophilia A, and 2 had hemophilia B.

The mean use of clotting factors per month during treatment and after treatment lower than before treatment

JAMA

Hemophilia was severe in 3 patients, moderate in 2, and mild in 3 whilst 4 patients had been previously treated with interferon alfa-2b alone, but Hepatitis C virus had not been eradicated.

The investigators compared the average use of clotting factors from the 5 patients with moderate and severe hemophilia before, during, and after treatment.

Oral ribavirin was administered by the researchers at a dose of 600 mg/d for patients who weighed 60 kg or less and 800 mg/d for those who weighed more than 60 kg during 24 weeks.

The research team reduced the dose of ribavirin by 200 mg/d if the patient’s hemoglobin concentration decreased to below 10 g/dL due to hemolytic anemia induced by ribavirin; the hemoglobin level did not fall this low from any other causes.

In the 5 patients requiring clotting factor, the mean use of clotting factors per month for the 6 months prior to combination therapy was 3783 U/mo.

During therapy, the mean use of clotting factors per month was 1605 U/mo; and for the 6 months after therapy it was 1667 U/mo.

The researchers concluded that the mean use of clotting factors per month during treatment and after treatment lower than before treatment.

Dr Takamatsu concludes, “Based on this case series, ribavirin in combination with IFN, and possibly alone, may reduce the use of clotting factors in patients with hemophilia and chronic hepatitis C.”

“Further studies, including replication of these findings and clinical trials, would help to clarify the potential role of ribavirin in these patients.”